Causes of Urinary Retention in Elderly Women

Urinary retention in elderly women is a fairly common problem associated with the physiological changes of aging. With time, the muscles of the bladder and urethra become weaker, which can lead to patients experiencing difficulties with complete bladder emptying. As a rule, this problem becomes relevant after the age of 70, particularly in those who have been bedridden for 3 months or more. Patients who remain mobile are generally not susceptible to this ailment, even if they are 80, 90, or older.

The most frequent cause of this phenomenon is bladder atony. Although it is more correct to call it dystonia—an impairment of tone. I must note that this accounts for more than 90% of cases.
Another cause is the weakening of the bladder and pelvic floor muscles, which leads to a deterioration of bladder control. However, this cause more often leads to uncontrolled urine leakage (incontinence) rather than actual retention.
It is often said that women experience urination problems due to hormonal balance changes caused by menopause. In my 25 years of practice, I have rarely encountered menopause as the primary standalone cause of acute retention in bedridden patients.
Other possible causes include:

• Urological diseases: Such as urolithiasis (kidney stones) or severe urinary tract infections. This is extremely rare and usually occurs only in cases of very advanced, neglected inflammation.
• Tumors: Growths in the vaginal area that compress the urinary canal. Such tumors are rare but always require catheter installation.
• Neurological conditions: Diseases that disrupt the spinal cord function. For example, multiple sclerosis. Unfortunately, this is a frequent and severe complication of advanced forms of this disease.

In cases of acute urinary retention in elderly women, it is necessary to seek help from a urologist immediately.
To alleviate the condition, urgent bladder catheterization is required. In these cases, the catheter is installed for a long-term period—one might say on a permanent basis. However, it must be changed for a new one every 25 days. Fortunately, this procedure is not difficult to perform at home. In women, a size 18 catheter is usually installed. The material (silicone, latex, or silver-plated) does not fundamentally matter; after 3–4 weeks, it must be replaced with a new one.
Secondly, a thorough examination is conducted to identify the root causes. The doctor may prescribe blood and urine tests, ultrasound examination of the pelvic organs, cystoscopy, and other diagnostic methods. An examination by a gynecologist is also mandatory.
How to properly care for a urinary catheter at home
When a catheter is installed, it is vital to ensure proper care to prevent infections and other complications.

1. Hygiene: Before any manipulation, perform thorough hygienic hand washing (and glove disinfection if applicable).
2. Inspection: Regularly check the area where the catheter enters the urethra, as well as the surrounding skin, for signs of inflammation or irritation. Signs of infection—such as pain, redness, swelling, or an unusual odor—require an immediate consultation with a urologist or gynecologist.
3. Drainage: Monitor the fluid level in the drainage bag and empty it regularly. The urine collector (bag) should ideally be changed once every 5–7 days.
4. Local care: It is advisable to wipe the vaginal area with a wet wipe 2 times a day.
5. No flushing: I must emphasize that no internal flushing of the catheter tube is required. Attempting to flush it often introduces bacteria into the bladder.
6. Replacement: If you suspect the catheter is blocked or if the tube has fallen out, it must be replaced with a new one immediately. Reusing a catheter that has been pulled out is strictly prohibited.

Key words: urinary retention in elderly women, acute urinary retention, bladder atony, catheterization, Foley catheter, catheter care, urinary incontinence, pelvic floor muscles, menopause, urological diseases, spinal cord disorders, multiple sclerosis, catheter replacement